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Diabetes Care. 2019 Jun 8. pii: dc190548. doi: 10.2337/dc19-0548. [Epub ahead of print]

Exploring Patient Preferences for Adjunct-to-Insulin Therapy in Type 1 Diabetes.

Author information

1
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Division of Endocrinology and Metabolism, University of Toronto, Toronto, Canada bruce.perkins@sinaihealthsystem.ca nima.soleymanlou@boehringer-ingelheim.com.
2
Dallas Diabetes Research Center at Medical City, Dallas, TX, USA.
3
Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
4
Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
5
Toronto General Hospital, Division of Nephrology, University of Toronto, Toronto, Canada.
6
Clinical and Experimental Endocrinology, University Hospital Leuven, Leuven, Belgium.
7
dQ&A - The Diabetes Research Company, San Francisco, CA, USA.
8
Boehringer Ingelheim International GmbH, Ingelheim, Germany.
9
Boehringer Ingelheim Canada Ltd/Ltée, Burlington, Canada bruce.perkins@sinaihealthsystem.ca nima.soleymanlou@boehringer-ingelheim.com.

Abstract

OBJECTIVE:

While sodium-glucose cotransporter inhibitor (SGLTi) therapy has been evaluated in type 1 diabetes (T1D) trials, patient reaction to benefits and risks are unknown. Using established methodology, we evaluated patient preferences for different adjunct-to-insulin therapy options in T1D.

RESEARCH DESIGN AND METHODS:

An online survey, completed by 701 respondents with T1D (231 US, 242 Canada, 228 Germany), used conjoint analysis to present 6 hypothetical, masked, pairwise drug profile choices composed of different benefit-risk attributes and effect ranges. Data used in analyses were derived from actual phase 3 trials of a low-dose SGLTi (comparable to oral empagliflozin 2.5 mg one daily); a high-dose SGLTi (comparable to oral sotagliflozin 400 mg once daily); and an available adjunct-to-insulin therapy (comparable to subcutaneous pramlintide 60 μg three times daily).

RESULTS:

Conjoint analysis identified diabetic ketoacidosis risk as most important to patients (23% relative score; z-test, P < 0.05). Secondly, were HbA1c reduction (14%), risk of severe hypoglycemia (13%), oral vs. injectable treatment (12%), and risk of genital infection (12%). Next was risk of nausea (11%), followed by weight reduction (8%) and the risk of diarrhea (7%). A low-dose SGLTi drug profile was identified by conjoint analysis as the top patient preference (83% of participants; z-test, P < 0.05) versus high-dose SGLTi (8%) or pramlintide (9%). Separate from conjoint analysis, when asked to choose their preferred adjunct-to-insulin therapy (masked to drug name/dose), 69%, 17%, 6%, and 9% of respondents chose low-dose SGLTi, high-dose SGLTi, pramlintide, and insulin therapy alone, respectively.

CONCLUSIONS:

Low-dose SGLTi profile was the favored adjunct-to-insulin therapy by persons with T1D.

PMID:
31177179
DOI:
10.2337/dc19-0548

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